| NPI | 1629349212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: SC 36030) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IL 051-290824) |
| 183500000X Pharmacist (Licence: NJ 28RI01886300) | |
| Enumeration Date | 2012-01-13 |
| Last Update Date | 2026-06-12 |