| NPI | 1790259174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY I061289-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT.0013136) |
| 183500000X Pharmacist (Licence: NJ 28RI03766100) | |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2019-01-18 |