| NPI | 1710414701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 056366) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI02989200) |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2017-05-22 |