| NPI | 1497069272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02944300) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP439845) |
| 183500000X Pharmacist (Licence: DE DE A1-0003537) | |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2010-08-03 |