| NPI | 1902355100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03597400) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 061651) |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2023-02-02 |