| NPI | 1104140557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT 0015613) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI02994800) |
| Enumeration Date | 2010-03-15 |
| Last Update Date | 2023-03-10 |