| NPI | 1558345603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI01557700) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP029223L) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2007-07-08 |