| NPI | 1629300918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 035835-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28R103258300) |
| Enumeration Date | 2010-02-11 |
| Last Update Date | 2010-03-03 |