| NPI | 1720224975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02921000) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH024063) |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2022-05-03 |