| NPI | 1861708067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS48644) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI02653600) |
| Enumeration Date | 2010-08-25 |
| Last Update Date | 2013-01-17 |