| NPI | 1386363141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S025990) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI04271500) |
| 183500000X Pharmacist (Licence: NY 071028) | |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2023-10-29 |