| NPI | 1972826915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 051839-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 14191) |
| 183500000X Pharmacist (Licence: NJ 28RI02868800) | |
| Enumeration Date | 2010-03-04 |
| Last Update Date | 2010-03-04 |