| NPI | 1780128637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 062513) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03820700) |
| Enumeration Date | 2016-12-12 |
| Last Update Date | 2025-11-10 |