| NPI | 1922540632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI03642500) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH235784) |
| 183500000X Pharmacist (Licence: NY 060142) | |
| 183500000X Pharmacist (Licence: TN 40739) | |
| 183500000X Pharmacist (Licence: VA 0202215441) | |
| Enumeration Date | 2016-11-11 |
| Last Update Date | 2016-11-11 |