| NPI | 1285636761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02831300) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 14402) |
| 183500000X Pharmacist (Licence: PA rp437415) | |
| 183500000X Pharmacist (Licence: DE a10003261) | |
| Enumeration Date | 2005-08-13 |
| Last Update Date | 2007-07-08 |