| NPI | 1295068963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ME PR5082) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: RI RPH03173) |
| 183500000X Pharmacist (Licence: MA PH20121) | |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2009-09-14 |