| NPI | 1003185364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 056709) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03406600) |
| Enumeration Date | 2011-12-15 |
| Last Update Date | 2018-06-26 |