| NPI | 1952757270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP440365) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03118200) |
| 183500000X Pharmacist (Licence: OK 8843) | |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2016-05-05 |