| NPI | 1891048591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03615900) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH234156) |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2016-07-16 |