| NPI | 1730448648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI01970800) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 033571) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2012-05-11 |