| NPI | 1912653148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI04232800) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 70099) |
| Enumeration Date | 2022-02-25 |
| Last Update Date | 2022-02-25 |