| NPI | 1720217649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS30171) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI02272000) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2023-02-07 |