| NPI | 1225158827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 048288) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 21400) |
| 183500000X Pharmacist (Licence: MD 13958) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2007-07-09 |