| NPI | 1164903639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ME pr46181) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH 4248) |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2018-08-23 |