| NPI | 1316236094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DE A10003602) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03087300) |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2012-07-11 |