| NPI | 1801125885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 053869) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT.0011480) |
| 183500000X Pharmacist (Licence: NJ 28RI03343400) | |
| 183500000X Pharmacist (Licence: PA RP449307) | |
| Enumeration Date | 2009-12-21 |
| Last Update Date | 2015-03-08 |