| NPI | 1770922494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP447055) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03546400) |
| Enumeration Date | 2013-06-15 |
| Last Update Date | 2013-06-15 |