| NPI | 1245637594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 060176) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03674900) |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2022-07-21 |