| NPI | 1306154117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28r101242900) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: NJ 28R101242900) |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2010-09-15 |