| NPI | 1164706743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 21697) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI01994500) |
| 183500000X Pharmacist (Licence: PA RP030296L) | |
| 183500000X Pharmacist (Licence: NJ 28RJ03098) | |
| Enumeration Date | 2011-09-30 |
| Last Update Date | 2021-02-24 |