| NPI | 1508201922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP-032089-L) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ RI-16619) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2013-04-30 |