| NPI | 1861769481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03064300) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 044621-1) |
| Enumeration Date | 2011-11-28 |
| Last Update Date | 2013-01-22 |