| NPI | 1124453295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS64425) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03559900) |
| Enumeration Date | 2013-09-09 |
| Last Update Date | 2025-03-07 |