| NPI | 1447559117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03365300) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 060255) |
| Enumeration Date | 2011-03-21 |
| Last Update Date | 2020-12-11 |