| NPI | 1619386893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02669900) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP440870) |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2015-06-19 |