| NPI | 1346554292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28r103335200) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 18625) |
| 183500000X Pharmacist (Licence: MI 5302037725) | |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2010-08-03 |