| NPI | 1366445124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS 41785) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ RI15676) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2013-01-16 |