| NPI | 1114666054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 069897) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI04243400) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2024-01-20 |