| NPI | 1538491154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 049480) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI02769400) |
| Enumeration Date | 2010-02-07 |
| Last Update Date | 2020-11-04 |