| NPI | 1285285999 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS40778) | 
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28ri03093000) | 
| Enumeration Date | 2019-09-24 | 
| Last Update Date | 2019-09-24 |