| NPI | 1457768095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28ri02239100) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA rp044431r) |
| 183500000X Pharmacist (Licence: FL ps28029) | |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2014-07-15 |