| NPI | 1164585279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02317500) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 20049615) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2007-07-08 |