| NPI | 1770170789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP035397L) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI02141400) |
| 183500000X Pharmacist (Licence: HI PH1315) | |
| Enumeration Date | 2020-12-23 |
| Last Update Date | 2020-12-23 |