| NPI | 1154699270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT PCT.0010467) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI02832200) |
| Enumeration Date | 2011-12-03 |
| Last Update Date | 2011-12-03 |