| NPI | 1457883670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03742300) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202215464) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2017-03-28 |