| NPI | 1598984643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS53264) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28ri02636400) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2018-05-09 |