| NPI | 1710135447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 031167) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 052327) |
| Enumeration Date | 2008-09-06 |
| Last Update Date | 2008-09-06 |