| NPI | 1780064543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY I057806-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03530500) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2015-06-05 |