| NPI | 1104498732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NH PHCY-01155) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VT 033.0134475) |
| Enumeration Date | 2021-07-13 |
| Last Update Date | 2021-07-13 |