| NPI | 1497087613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 053821) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT.0011706) |
| 183500000X Pharmacist (Licence: NJ 28RI03485700) | |
| Enumeration Date | 2010-02-13 |
| Last Update Date | 2015-05-14 |