| NPI | 1760769053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ME PR4427) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VT 033.0003343) |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2011-11-15 |