| NPI | 1245996453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: NJ 28RS00408000) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03262800) |
| Enumeration Date | 2021-11-11 |
| Last Update Date | 2021-11-11 |