| NPI | 1265188650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI04217000) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 067981) |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2022-05-15 |