| NPI | 1053746909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03450000) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA Rp447628) |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2013-09-11 |