| NPI | 1780772087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ RI23097) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 41559) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2007-07-08 |