| NPI | 1730749946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: NJ 28RC00012400) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03171000) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2019-06-19 |