| NPI | 1598020620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03439700) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202211449) |
| Enumeration Date | 2012-07-04 |
| Last Update Date | 2012-07-04 |