| NPI | 1154748804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 062739) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03613500) |
| Enumeration Date | 2014-03-19 |
| Last Update Date | 2025-11-20 |