| NPI | 1205469863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03295400) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 15761-40) |
| Enumeration Date | 2020-02-21 |
| Last Update Date | 2022-06-04 |