| NPI | 1083155873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 058900) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03707200) |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2017-03-14 |