| NPI | 1124597067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03758800) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 065023) |
| Enumeration Date | 2018-11-21 |
| Last Update Date | 2018-11-21 |