| NPI | 1497035406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ME PR13128) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP445676) |
| 183500000X Pharmacist (Licence: NY 056766) | |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2014-06-23 |