| NPI | 1346797974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist Ambulatory Care (Licence: NH PHCY-01338) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH236868) |
| 1835P2201X Pharmacist Ambulatory Care (Licence: MA PH236868) | |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2023-06-05 |