| NPI | 1255337044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 23841) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: RI 3827) |
| 183500000X Pharmacist (Licence: ME PR4621) | |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: MA 299101) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2007-07-08 |