| NPI | 1710396189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ME PR27878) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH1002075) |
| 183500000X Pharmacist (Licence: NH r2548) | |
| Enumeration Date | 2014-08-10 |
| Last Update Date | 2026-05-26 |