| NPI | 1952787095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP026348L) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI01661200) |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2015-07-30 |