| NPI | 1770991598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 058963) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03608100) |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2020-01-02 |