| NPI | 1740552835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: MA PH232796) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH232796) |
| Enumeration Date | 2012-02-03 |
| Last Update Date | 2018-12-26 |