| NPI | 1518365634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03700100) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RPI012919) |
| 183500000X Pharmacist (Licence: MD 22988) | |
| 183500000X Pharmacist (Licence: DC PH100001857) | |
| Enumeration Date | 2014-12-06 |
| Last Update Date | 2020-12-08 |