| NPI | 1811215189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI01962900) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP034606L) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2010-05-12 |