| NPI | 1649551656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DE A1-0004089) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03422800) |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2011-09-02 |