| NPI | 1114388493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RIO1465000) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP028193L) |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2016-03-14 |