| NPI | 1659615631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ME PR5977) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH233258) |
| 183500000X Pharmacist (Licence: CA 68867) | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2016-11-11 |