| NPI | 1679627210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT 6224) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 14788) |
| 183500000X Pharmacist (Licence: NH 1728) | |
| 183500000X Pharmacist (Licence: VT 2831) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-07-08 |