| NPI | 1376875484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 039302-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 19667) |
| 183500000X Pharmacist (Licence: FL ps25237) | |
| Enumeration Date | 2010-02-01 |
| Last Update Date | 2010-02-01 |