| NPI | 1467858241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI01695300) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 20061) |
| Enumeration Date | 2014-11-06 |
| Last Update Date | 2014-11-06 |