| NPI | 1609415579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 066437) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI04076700) |
| Enumeration Date | 2019-12-24 |
| Last Update Date | 2020-01-16 |