| NPI | 1538535968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03772400) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS53954) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2020-10-01 |