| NPI | 1235606112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI04074800) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT.0015098) |
| 183500000X Pharmacist (Licence: SC 38084) | |
| 183500000X Pharmacist (Licence: DC PH100003440) | |
| Enumeration Date | 2018-10-29 |
| Last Update Date | 2020-04-07 |