| NPI | 1477859569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03623000) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 055445) |
| Enumeration Date | 2011-02-07 |
| Last Update Date | 2014-03-18 |