| NPI | 1760747182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 057087) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03492600) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2013-09-30 |