| NPI | 1770599235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02953500) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: NJ 2295) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2011-06-22 |