| NPI | 1609371947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT PCT.0013624) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI04045700) |
| 183500000X Pharmacist (Licence: NY 068884) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2022-03-05 |