| NPI | 1104053131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP-030407L) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI01530100) |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2009-06-17 |