| NPI | 1619465390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03625300) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT.0013149) |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2019-03-04 |