| NPI | 1326430604 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH234725) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 058127) |
| 183500000X Pharmacist (Licence: FL PS52597) | |
| Enumeration Date | 2015-02-24 |
| Last Update Date | 2015-02-24 |