| NPI | 1104427939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP035978L) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RIO2676900) |
| Enumeration Date | 2020-11-06 |
| Last Update Date | 2020-11-06 |