| NPI | 1619283207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02857500) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS 46113) |
| 183500000X Pharmacist (Licence: NY 054440-1) | |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2010-08-20 |