| NPI | 1912343872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03210800) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 17650) |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2013-05-20 |