| NPI | 1811200371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03112000) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS38270) |
| 183500000X Pharmacist (Licence: NY 000220) | |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2010-07-26 |