| NPI | 1790091742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02691200) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DE A1-0003048) |
| Enumeration Date | 2010-08-27 |
| Last Update Date | 2012-04-01 |