| NPI | 1639410111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DE A1-0005377) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 0405547) |
| 183500000X Pharmacist (Licence: MA PH239819) | |
| 183500000X Pharmacist (Licence: PA RP043707R) | |
| Enumeration Date | 2013-03-08 |
| Last Update Date | 2020-11-02 |