| NPI | 1093923898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 16258) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH R1023) |
| 183500000X Pharmacist (Licence: CT 6043) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2012-02-01 |