| NPI | 1164792594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ME 4237) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VT 0330003780) |
| 183500000X Pharmacist (Licence: NH r2153) | |
| 183500000X Pharmacist (Licence: MA ph22593) | |
| Enumeration Date | 2012-01-02 |
| Last Update Date | 2012-01-02 |