| NPI | 1164983102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI04025800) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: NY 064766) |
| Enumeration Date | 2019-03-30 |
| Last Update Date | 2021-05-25 |