| NPI | 1902240146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02187700) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 057729) |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2013-04-18 |