| NPI | 1821678665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NH PHCY-00944) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VT 033.0134309) |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2022-10-20 |