| NPI | 1518452242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH237710) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH PHCY-04337) |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2018-06-26 |