| NPI | 1598087165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 047764) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ RI024827) |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2011-11-15 |