| NPI | 1871876565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28rI03075800) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT pct0010320) |
| 183500000X Pharmacist (Licence: NY 0524621) | |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2011-09-20 |