| NPI | 1629052048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 039852) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28R102328500) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2007-07-08 |