| NPI | 1184807109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ME PR4243) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH 2679) |
| 183500000X Pharmacist (Licence: CT 7415) | |
| 183500000X Pharmacist (Licence: FL PS 28481) | |
| 183500000X Pharmacist (Licence: VT 033-0003321) | |
| Enumeration Date | 2007-12-13 |
| Last Update Date | 2007-12-13 |