| NPI | 1104169085 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH26726) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: RI RPH04710) |
| Enumeration Date | 2013-03-29 |
| Last Update Date | 2013-03-29 |