| NPI | 1568971679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA ph238381) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ME PR46703) |
| Enumeration Date | 2017-09-21 |
| Last Update Date | 2021-01-04 |