| NPI | 1083915870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28ri03002400) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 20 055251) |
| Enumeration Date | 2010-11-09 |
| Last Update Date | 2010-11-10 |