| NPI | 1154549970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 19322) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ME PR4851) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2014-07-31 |