| NPI | 1669759577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA ph23734) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ME pr4722) |
| Enumeration Date | 2011-11-05 |
| Last Update Date | 2011-11-05 |