| NPI | 1316257975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 053919) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03158700) |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2014-03-25 |