| NPI | 1952558371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ME ph4865) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 21756) |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2008-08-27 |