| NPI | 1649567454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 49801) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03050400) |
| 183500000X Pharmacist (Licence: AZ S017864) | |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2011-06-30 |