| NPI | 1144476763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 051031) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 2791500) |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2008-08-14 |