| NPI | 1790308930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI04031400) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP453508) |
| 183500000X Pharmacist (Licence: CT PCT.0015186) | |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2022-10-06 |