| NPI | 1699212209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 060081) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 17138) |
| 183500000X Pharmacist (Licence: NJ 28RI03768700) | |
| Enumeration Date | 2017-01-21 |
| Last Update Date | 2017-01-21 |