| NPI | 1871806901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 17671) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH R1459) |
| Enumeration Date | 2010-07-18 |
| Last Update Date | 2010-07-18 |