| NPI | 1386317659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA 31556) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 18209) |
| Enumeration Date | 2021-07-31 |
| Last Update Date | 2021-07-31 |