| NPI | 1356635536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH18172) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH R1417) |
| 183500000X Pharmacist (Licence: ME PR5017) | |
| Enumeration Date | 2011-06-05 |
| Last Update Date | 2013-12-20 |