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 |