| NPI | 1053635094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03194200) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS31100) |
| Enumeration Date | 2010-03-19 |
| Last Update Date | 2010-03-19 |