| NPI | 1982918132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NJ 28RI02980300) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP026614L) |
| 183500000X Pharmacist (Licence: DE A1-0003450) | |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2010-07-29 |