| NPI | 1184992208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 268392-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28ri01875100) |
| Enumeration Date | 2011-12-03 |
| Last Update Date | 2011-12-03 |