| NPI | 1932442795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03915700) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S019398) |
| Enumeration Date | 2013-03-30 |
| Last Update Date | 2023-03-22 |