| NPI | 1982607164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ME PR3791) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 18109) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2008-03-29 |