| NPI | 1801021589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 052900) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 03071100) |
| Enumeration Date | 2009-05-24 |
| Last Update Date | 2010-03-16 |