| NPI | 1700197845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 02452000) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA 444486) |
| 183500000X Pharmacist (Licence: NY 048326) | |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2010-06-23 |