| NPI | 1821548942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03662600) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP450019) |
| Enumeration Date | 2016-10-13 |
| Last Update Date | 2023-04-25 |