| NPI | 1700020476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02481700) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 045852-1) |
| Enumeration Date | 2009-04-26 |
| Last Update Date | 2014-07-26 |