| NPI | 1235768656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 062824) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03867600) |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2020-04-07 |