| NPI | 1619320488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 25925) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03749500) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2016-11-10 |