| NPI | 1003103946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02981000) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 055559-1) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2011-06-29 |