| NPI | 1598041113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DE A1-0004003) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03430400) |
| 183500000X Pharmacist (Licence: PA RP443105) | |
| Enumeration Date | 2011-10-27 |
| Last Update Date | 2011-10-27 |