| NPI | 1902093792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 051840) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 16913) |
| 183500000X Pharmacist (Licence: NH 3374) | |
| 183500000X Pharmacist (Licence: NJ 28ri03062700) | |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2022-03-20 |