| NPI | 1396807996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 052363-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302034253) |
| 183500000X Pharmacist (Licence: NJ 28RI03111400) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2011-08-17 |