| NPI | 1164704144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02267900) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS40952) |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2011-09-15 |