| NPI | 1902188592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03450600) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P6165) |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2011-09-09 |