| NPI | 1033492558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28ri03322500) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 056688) |
| Enumeration Date | 2011-09-21 |
| Last Update Date | 2017-04-18 |