| NPI | 1891397873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 46880) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 054413) |
| 183500000X Pharmacist (Licence: NJ 28RI03241200) | |
| Enumeration Date | 2020-11-13 |
| Last Update Date | 2020-11-13 |