| NPI | 1275874968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI01845300) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 44707) |
| Enumeration Date | 2013-03-06 |
| Last Update Date | 2013-03-06 |