| NPI | 1992268940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC PH41900) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI01879400) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2019-04-08 |