| NPI | 1861805129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP445354) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RPI006334) |
| 183500000X Pharmacist (Licence: NJ 28RI02452800) | |
| 183500000X Pharmacist (Licence: SC PH8266) | |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2014-06-04 |