| NPI | 1215344957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 18156) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH R1005) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2014-07-15 |