| NPI | 1215230180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VT 3499) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH R2054) |
| 183500000X Pharmacist (Licence: MA 17645) | |
| Enumeration Date | 2010-12-14 |
| Last Update Date | 2010-12-14 |