| NPI | 1861164550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH236135) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH PHCY-04538) |
| Enumeration Date | 2021-09-30 |
| Last Update Date | 2021-09-30 |