| NPI | 1033494562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302037550) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28ri03433400) |
| Enumeration Date | 2011-10-16 |
| Last Update Date | 2011-10-16 |