| NPI | 1659888709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 063711) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28ri03532700) |
| Enumeration Date | 2018-01-10 |
| Last Update Date | 2018-03-17 |