| NPI | 1396488714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI04195500) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY I068808-01) |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2022-04-14 |