| NPI | 1699086413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03339500) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY I-054269) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2012-02-13 |