| NPI | 1134590656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03777700) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 061773) |
| Enumeration Date | 2015-10-09 |
| Last Update Date | 2021-11-03 |