| NPI | 1740557347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 55990) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03470800) |
| Enumeration Date | 2011-11-27 |
| Last Update Date | 2018-06-13 |