| NPI | 1114512977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: NY 067918) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI04165600) |
| Enumeration Date | 2021-03-03 |
| Last Update Date | 2022-05-25 |