| NPI | 1336473990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302036815) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28ri03174800) |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2022-04-18 |