| NPI | 1619388105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ ri020690) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 0409561) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2014-05-19 |