| NPI | 1851668438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH233381) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: RI RPH05002) |
| Enumeration Date | 2011-11-25 |
| Last Update Date | 2011-11-25 |