| NPI | 1770872772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DE A1-0003920) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03269500) |
| 183500000X Pharmacist (Licence: VA 0202209118) | |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2011-03-31 |