| NPI | 1851778211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02434400) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP041591L) |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2021-02-01 |