| NPI | 1720276181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP-439261) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH R2283) |
| 183500000X Pharmacist (Licence: MA PH233497) | |
| 183500000X Pharmacist (Licence: VT 033.0076653) | |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2012-08-07 |