| NPI | 1285048710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 060036) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03423000) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2025-11-18 |