| NPI | 1760762256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP039376L) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI02707400) |
| Enumeration Date | 2011-08-28 |
| Last Update Date | 2011-08-28 |