| NPI | 1790570489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 26635) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 27291) |
| Enumeration Date | 2025-04-12 |
| Last Update Date | 2025-04-12 |