| NPI | 1760826994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP446883) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03503900) |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2013-04-18 |