| NPI | 1194038299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP442690) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI04439600) |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2025-06-27 |