| NPI | 1659697852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT PCT.009165) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 049492-1) |
| 183500000X Pharmacist (Licence: NJ 28RI02680000) | |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2010-04-14 |