| NPI | 1043228257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02881300) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 000139) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2011-08-26 |