| NPI | 1801027859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 17615) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 29RI03070600) |
| 183500000X Pharmacist (Licence: MD 17369) | |
| 183500000X Pharmacist (Licence: MI 5302035682) | |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2009-08-06 |