| NPI | 1023425592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 21092) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28r103540600) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2014-07-16 |