| NPI | 1518465947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP451760) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03887300) |
| Enumeration Date | 2018-01-31 |
| Last Update Date | 2018-01-31 |