| NPI | 1255754370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03602000) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 059471) |
| Enumeration Date | 2014-01-24 |
| Last Update Date | 2014-07-26 |