| NPI | 1962486225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 046308) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 25963) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2010-03-11 |