| NPI | 1255932802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03830000) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP454415) |
| Enumeration Date | 2020-11-02 |
| Last Update Date | 2020-11-02 |