| NPI | 1548556095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 20-055636) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03193900) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2011-06-23 |