| NPI | 1336548569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: MA PH234175) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH234175) |
| Enumeration Date | 2014-08-13 |
| Last Update Date | 2019-06-11 |