| NPI | 1023468535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NH r1996) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH232722) |
| 183500000X Pharmacist (Licence: RI RPH04520) | |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2016-06-15 |