| NPI | 1790783298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 13991-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI02867500) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2008-05-31 |