| NPI | 1104184290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 058952) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03486900) |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2015-11-17 |