| NPI | 1154316982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI01543200) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 029243-1) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2007-07-08 |