| NPI | 1710358627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03683400) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202213943) |
| 183500000X Pharmacist (Licence: TX 60844) | |
| 183500000X Pharmacist (Licence: NY 067564) | |
| 183500000X Pharmacist (Licence: PA RP456122) | |
| 183500000X Pharmacist (Licence: MI 5302413208) | |
| 183500000X Pharmacist (Licence: TN 44006) | |
| Enumeration Date | 2015-10-18 |
| Last Update Date | 2022-10-17 |