| NPI | 1154699262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 50917) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03470500) |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2011-12-02 |