| NPI | 1578846366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS41418) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 055035) |
| 183500000X Pharmacist (Licence: NJ 28RI03412600) | |
| 183500000X Pharmacist (Licence: MI 5302036050) | |
| Enumeration Date | 2011-09-28 |
| Last Update Date | 2014-12-18 |