| NPI | 1851688675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH24227) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT PCT.0008704) |
| 183500000X Pharmacist (Licence: RI RPH03960) | |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2011-06-30 |