| NPI | 1750884599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT PCt.0015149) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 063949) |
| 183500000X Pharmacist (Licence: MA PH238066) | |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2022-12-06 |