| NPI | 1235115668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 039609) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 022344) |
| Enumeration Date | 2005-12-18 |
| Last Update Date | 2013-04-17 |