| NPI | 1619299773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 051821) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS42693) |
| 183500000X Pharmacist (Licence: NJ 28RI03147900) | |
| Enumeration Date | 2010-02-17 |
| Last Update Date | 2010-02-21 |