| NPI | 1033542972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28ri03560300) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA rp445056) |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2014-02-06 |