| NPI | 1699005405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI04082000) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 053861) |
| Enumeration Date | 2009-12-30 |
| Last Update Date | 2026-05-22 |