| NPI | 1184913360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY I057944-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03410800) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2015-10-05 |