| NPI | 1861711343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 20 055127) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03258700) |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2011-08-11 |