| NPI | 1821123449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 050694) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ RI 27232) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2009-02-25 |