| NPI | 1972944940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03382100) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 058748-1) |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2018-03-15 |