| NPI | 1932512795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VT 033.0078155) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH PHCY-00841) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2023-09-27 |