| NPI | 1811201783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 063796) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03335600) |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2025-07-17 |