| NPI | 1235373085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL 33398) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI02790300) |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2009-04-23 |