| NPI | 1649400029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02956900) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 052476) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2025-11-14 |