| NPI | 1104105899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03479600) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 055781) |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2021-04-26 |