| NPI | 1982812251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ME PR4868) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 09163) |
| Enumeration Date | 2007-05-19 |
| Last Update Date | 2021-09-21 |