| NPI | 1245249465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS45516) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI01779500) |
| 183500000X Pharmacist (Licence: PA RP042215R) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2020-08-18 |