| NPI | 1073768503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 053122) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 24605) |
| 183500000X Pharmacist (Licence: CT 11181) | |
| 183500000X Pharmacist (Licence: NJ 28RI03263200) | |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2016-05-13 |