| NPI | 1376865584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 051538) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI029318) |
| Enumeration Date | 2010-02-16 |
| Last Update Date | 2010-02-16 |