| NPI | 1164849402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ RI013124) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 027126) |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2014-03-25 |