| NPI | 1255658688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: RI RPH4706) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 48070) |
| Enumeration Date | 2010-04-25 |
| Last Update Date | 2010-04-25 |