| NPI | 1215088778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 2009300) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI02009300) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2020-07-22 |