| NPI | 1972871598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP441450) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03281000) |
| 183500000X Pharmacist (Licence: NY 057972) | |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2022-07-11 |