| NPI | 1912556085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP453792) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI04040900) |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2022-09-06 |