| NPI | 1427213842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 42143) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI02886000) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2023-05-26 |