| NPI | 1558632950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02289500) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 055579) |
| 183500000X Pharmacist (Licence: FL PS46924) | |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2012-01-18 |