| NPI | 1134255334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ME PR3865) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 14923) |
| Enumeration Date | 2007-02-24 |
| Last Update Date | 2007-07-08 |