| NPI | 1376982900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03436400) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP443624) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2019-06-07 |