| NPI | 1265111769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: RI RPH06662) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH241587) |
| Enumeration Date | 2023-07-13 |
| Last Update Date | 2024-07-02 |