| NPI | 1306231881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 037301) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI01815800) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2015-04-01 |