| NPI | 1376807982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA ph232776) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 2056785) |
| 183500000X Pharmacist (Licence: IL 051290328) | |
| 1835P1300X Pharmacist, Psychiatric (Licence: MA PH232776) | |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2023-03-31 |