| NPI | 1255624334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT 5345) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH16405) |
| 183500000X Pharmacist (Licence: NH 1991) | |
| 183500000X Pharmacist (Licence: VT 033.0002830) | |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2011-05-23 |