| NPI | 1952554347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03140600) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 053039) |
| 183500000X Pharmacist (Licence: FL PS42748) | |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2012-09-28 |