| NPI | 1306468921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 068543) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI04091600) |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2022-06-07 |