| NPI | 1124789078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI04272400) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 85813) |
| Enumeration Date | 2022-01-03 |
| Last Update Date | 2022-10-22 |