| NPI | 1619036415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT 9801) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 26605) |
| 183500000X Pharmacist (Licence: RI 04786) | |
| 183500000X Pharmacist (Licence: ME 5991) | |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2012-12-17 |