| NPI | 1629196662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 52139) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ME pr4609) |
| 183500000X Pharmacist (Licence: MA PH22660) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2022-07-20 |