| NPI | 1619676145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH238139) |
| Additional Taxonomies | 1835P0200X Pharmacist Pediatrics (Licence: MA 8151440) |
| Enumeration Date | 2023-02-23 |
| Last Update Date | 2023-02-23 |