| NPI | 1508181587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 21863) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MA 21863) |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2010-04-01 |