| NPI | 1225558042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02741900) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302037772) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2022-07-21 |