| NPI | 1326617325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: MA PH997216) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: NC 28075) |
| 1835P2201X Pharmacist, Ambulatory Care (Licence: GA RPH032099) | |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2024-04-04 |