| NPI | 1972105088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP453006) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS55586) |
| 183500000X Pharmacist (Licence: NJ 28RI04114300) | |
| Enumeration Date | 2020-11-12 |
| Last Update Date | 2020-11-12 |