| NPI | 1659614071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT PCT.0012381) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 058714) |
| 183500000X Pharmacist (Licence: NH R2680) | |
| 183500000X Pharmacist (Licence: MA PH236414) | |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2020-11-16 |