| NPI | 1376908608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY I037231) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ RI02008700) |
| Enumeration Date | 2015-12-31 |
| Last Update Date | 2015-12-31 |