| NPI | 1962783167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI027806) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH24591) |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2011-08-31 |