| NPI | 1710438148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03793800) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: NJ 3161444) |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2025-06-02 |