| NPI | 1063781755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 055922) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP439215) |
| 183500000X Pharmacist (Licence: NJ 28RI03051400) | |
| 183500000X Pharmacist (Licence: MD 16766) | |
| Enumeration Date | 2011-12-26 |
| Last Update Date | 2011-12-26 |