| NPI | 1073829016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 20 053592) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03319400) |
| Enumeration Date | 2010-08-27 |
| Last Update Date | 2010-08-27 |