| NPI | 1144668328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03551200) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RJ04739) |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2013-06-10 |