| NPI | 1902181308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202209689) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03422000) |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2011-10-17 |