| NPI | 1760764997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA MA25956) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS44742) |
| 183500000X Pharmacist (Licence: GA RPH025892) | |
| 183500000X Pharmacist (Licence: NJ 28RI03241000) | |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2011-09-14 |