| NPI | 1144566456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RIO3424300) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 057614) |
| Enumeration Date | 2012-12-14 |
| Last Update Date | 2021-07-20 |