| NPI | 1306241757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03189800) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DE A1-0004392) |
| Enumeration Date | 2014-10-28 |
| Last Update Date | 2014-10-28 |