| NPI | 1881189769 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 063919) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH237974) |
| Enumeration Date | 2018-06-24 |
| Last Update Date | 2018-06-24 |