| NPI | 1972917797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 17557) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03139200) |
| 183500000X Pharmacist (Licence: NY 20 056332) | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2014-06-19 |