| NPI | 1770689077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28 RI01498300) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38mc00301100) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2007-07-08 |