| NPI | 1730792474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS60456) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03827700) |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2022-12-17 |