| NPI | 1124622030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 81272) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: NJ 28RJ07964) |
| Enumeration Date | 2020-11-23 |
| Last Update Date | 2022-12-20 |