| NPI | 1235298456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 048918-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 02564200) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2010-03-05 |