| NPI | 1508141201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02883800) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S12628) |
| 183500000X Pharmacist (Licence: PA RP438108) | |
| Enumeration Date | 2011-10-14 |
| Last Update Date | 2011-10-14 |