| NPI | 1144501347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ps48724) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ME pr5627) |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2019-06-05 |