| NPI | 1649502246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 053448) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI02087700) |
| 183500000X Pharmacist (Licence: PA RP444043) | |
| Enumeration Date | 2010-02-05 |
| Last Update Date | 2012-05-07 |