| NPI | 1659885077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03994700) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302045693) |
| 183500000X Pharmacist (Licence: DC PH100002750) | |
| Enumeration Date | 2017-11-21 |
| Last Update Date | 2019-04-19 |