| NPI | 1902892144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02097400) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 049525) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2011-07-06 |