| NPI | 1154644995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP439328) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RIO2993900) |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2010-03-08 |