| NPI | 1679997514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NH r1983) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VT 033.100439) |
| 183500000X Pharmacist (Licence: CT pct.0008807) | |
| Enumeration Date | 2014-02-12 |
| Last Update Date | 2014-03-18 |