| NPI | 1528593621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 043578) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP439907) |
| 183500000X Pharmacist (Licence: NJ 28RI02993100) | |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2017-04-26 |