| NPI | 1619017936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS34606) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 025066) |
| 183500000X Pharmacist (Licence: NJ 27779) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2007-07-08 |