| NPI | 1033366588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 052355) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28ri03172900) |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2011-06-30 |