| NPI | 1760638233 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 27074) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH R2695) |
| 183500000X Pharmacist (Licence: MA PH27074) | |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2021-06-29 |