| NPI | 1689260655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NH PHCY-00986) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VT 033.0134355) |
| 183500000X Pharmacist (Licence: CT PCT.0015145) | |
| 183500000X Pharmacist (Licence: MA PH238714) | |
| Enumeration Date | 2020-12-14 |
| Last Update Date | 2020-12-14 |