| NPI | 1942411129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 046314) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ RI025961) |
| Enumeration Date | 2007-05-27 |
| Last Update Date | 2012-02-28 |