| NPI | 1184969727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ME pr12570) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH236183) |
| Enumeration Date | 2012-12-08 |
| Last Update Date | 2016-02-16 |