| NPI | 1700018975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03984400) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 053252) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2020-12-03 |