| NPI | 1093159097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 057862) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 52504) |
| 183500000X Pharmacist (Licence: NJ 28RI03550300) | |
| 183500000X Pharmacist (Licence: CT PCT.0012507) | |
| Enumeration Date | 2013-04-20 |
| Last Update Date | 2013-04-20 |