| NPI | 1497012546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02273300) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV 271058) |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2012-04-13 |