| NPI | 1689091472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03153100) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS42552) |
| 183500000X Pharmacist (Licence: GU PH0184) | |
| Enumeration Date | 2014-03-18 |
| Last Update Date | 2014-03-18 |