| NPI | 1548914062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 060502) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI04135800) |
| Enumeration Date | 2022-02-04 |
| Last Update Date | 2022-02-04 |