| NPI | 1265754741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 052909) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03049700) |
| Enumeration Date | 2010-02-24 |
| Last Update Date | 2015-04-02 |