| NPI | 1861715088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VT 033.0003523) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 053588-1) |
| 183500000X Pharmacist (Licence: MA 25796) | |
| Enumeration Date | 2010-03-02 |
| Last Update Date | 2010-08-16 |