| NPI | 1063642924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02143900) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 15213) |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2009-07-24 |