| NPI | 1548555352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VT 033.0052966) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202209770) |
| 183500000X Pharmacist (Licence: MA PH232502) | |
| 183500000X Pharmacist (Licence: NH R2228) | |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2011-06-09 |