| NPI | 1538463088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NH R2310) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI02942900) |
| 183500000X Pharmacist (Licence: AK 1827) | |
| Enumeration Date | 2010-12-27 |
| Last Update Date | 2014-08-04 |