| NPI | 1154634848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH233115) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ME pr5728) |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2020-11-11 |