| NPI | 1558644666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH232498) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: RI RPH04871) |
| Enumeration Date | 2011-09-25 |
| Last Update Date | 2011-09-25 |