| NPI | 1104097203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03056500) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH 3338) |
| 183500000X Pharmacist (Licence: NY 000167) | |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2008-03-17 |