| NPI | 1497016703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 20470) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ME PR5756) |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2015-07-24 |