| NPI | 1871861062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03463000) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS57368) |
| 183500000X Pharmacist (Licence: NY 057667) | |
| 183500000X Pharmacist (Licence: CT PCT.0012198) | |
| 183500000X Pharmacist (Licence: NV 23452) | |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2023-11-14 |