| NPI | 1346528205 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH233673) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: RI RPH05063) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2011-11-05 |