| NPI | 1316210164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH27428) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MA 3100213) |
| Enumeration Date | 2012-02-09 |
| Last Update Date | 2012-02-09 |