| NPI | 1215257704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02521900) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 052179) |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2012-09-12 |