| NPI | 1124390471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 056560-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03030900) |
| Enumeration Date | 2012-02-02 |
| Last Update Date | 2012-02-02 |