| NPI | 1043484058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 042311) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS28375) |
| 183500000X Pharmacist (Licence: NJ 28RI02292100) | |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2020-07-08 |