| NPI | 1215013230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28r102239000) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 042736) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2020-12-04 |