| NPI | 1982740916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS32004) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ RI23588) |
| 183500000X Pharmacist (Licence: FL PU6767) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2024-02-09 |