| NPI | 1326314162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: NJ 28RI02709000) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: NY 031551-1) |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2012-03-27 |