| NPI | 1902125651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH236544) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI02733000) |
| Enumeration Date | 2010-05-20 |
| Last Update Date | 2026-07-15 |