| NPI | 1225432636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02874200) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 045553) |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2014-10-14 |