| NPI | 1144652983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 057656) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03450500) |
| Enumeration Date | 2013-08-03 |
| Last Update Date | 2013-08-03 |