| NPI | 1699017269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03438600) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 057727) |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2026-05-08 |