| NPI | 1487979399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 16671) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 10603) |
| 183500000X Pharmacist (Licence: NJ 28RI01517200) | |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2010-04-02 |