| NPI | 1679069397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03841500) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 062258) |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2022-10-05 |