| NPI | 1760713879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 049073) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI02867300) |
| Enumeration Date | 2010-01-29 |
| Last Update Date | 2010-01-29 |