| NPI | 1952188310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI04319800) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 070688) |
| Enumeration Date | 2023-09-11 |
| Last Update Date | 2023-11-02 |