| NPI | 1235688029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03814900) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 064192) |
| Enumeration Date | 2016-09-22 |
| Last Update Date | 2020-07-20 |