| NPI | 1689703076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 051425-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 025460) |
| 183500000X Pharmacist (Licence: NJ 28RI03044200) | |
| Enumeration Date | 2007-03-03 |
| Last Update Date | 2007-07-08 |