| NPI | 1063056240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS38531) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI02269700) |
| Enumeration Date | 2019-10-31 |
| Last Update Date | 2019-10-31 |