| NPI | 1447641220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03896100) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: NJ 28RW02253800) |
| Enumeration Date | 2015-02-14 |
| Last Update Date | 2020-12-01 |