| NPI | 1629296678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VT 033-0002488) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH 1846) |
| 183500000X Pharmacist (Licence: FL ps 28411) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2007-07-08 |