| NPI | 1396391959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI04262700) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: NJ 99109065) |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: NJ 3163337) | |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2026-06-30 |