| NPI | 1851878607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH237712) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03936700) |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2018-07-24 |