| NPI | 1245807643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY I070737) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI04160700) |
| Enumeration Date | 2021-06-05 |
| Last Update Date | 2025-10-15 |