| NPI | 1841896610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY I070214-01) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI04144200) |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2024-09-13 |