| NPI | 1477763274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI01678800) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS19709) |
| 183500000X Pharmacist (Licence: PA RP032115L) | |
| 183500000X Pharmacist (Licence: NE 12244) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2025-11-14 |