| NPI | 1851779300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 056793) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI01603900) |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2015-05-15 |