| NPI | 1396154134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT 0010733) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH26957) |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2014-08-06 |