| NPI | 1659679488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ME pr4120) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 19126) |
| Enumeration Date | 2011-03-02 |
| Last Update Date | 2012-08-04 |