| NPI | 1396926432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 047323) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 24265) |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2007-11-16 |