| NPI | 1508242918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist Ambulatory Care (Licence: MA PH236081) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH236081) |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2023-05-16 |