| NPI | 1629331533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH24837) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP439821) |
| 183500000X Pharmacist (Licence: NY 050723) | |
| 183500000X Pharmacist (Licence: NJ 28RI03101000) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2012-06-18 |