| NPI | 1215328125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 060144) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03686200) |
| Enumeration Date | 2015-02-13 |
| Last Update Date | 2016-12-13 |