| NPI | 1629493002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28ri02002900) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 037709-1) |
| Enumeration Date | 2014-02-21 |
| Last Update Date | 2014-02-21 |