| NPI | 1114357001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 55390) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03261300) |
| Enumeration Date | 2013-11-14 |
| Last Update Date | 2024-08-12 |