| NPI | 1598214413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 62174) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03842600) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2017-01-10 |