| NPI | 1801882048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02536000) |
| Additional Taxonomies | 1835P1300X Pharmacist, Psychiatric (Licence: NJ 28RI02536000) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2015-03-08 |