| NPI | 1881005106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI 02870300) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP031527L) |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2014-05-09 |