| NPI | 1790093318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 20927) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ RI01530400) |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2010-09-16 |