| NPI | 1336510213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 24685) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03659300) |
| Enumeration Date | 2015-10-17 |
| Last Update Date | 2015-10-17 |