| NPI | 1487934626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03165100) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP444864) |
| 183500000X Pharmacist (Licence: NC 18567) | |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: CT PCT 9925) | |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2011-08-19 |