| NPI | 1184966863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03489200) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 52405) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2013-03-20 |