| NPI | 1700177052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: RI RPH01802) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH14657) |
| 183500000X Pharmacist (Licence: CT PCT.0007541) | |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2011-04-20 |