| NPI | 1871004135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 063862) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03900100) |
| Enumeration Date | 2017-10-13 |
| Last Update Date | 2018-02-14 |