| NPI | 1629853346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH241701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: RI RPH06660) |
| Enumeration Date | 2023-08-30 |
| Last Update Date | 2025-11-06 |