| NPI | 1407025695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ME PR3247) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: RI RPH02310) |
| 183500000X Pharmacist (Licence: NH 2118) | |
| Enumeration Date | 2008-02-21 |
| Last Update Date | 2008-02-21 |