| NPI | 1891910493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02248200) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS30911) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2007-07-08 |