| NPI | 1073300257 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS36720) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11036872) |
| Enumeration Date | 2025-04-22 |
| Last Update Date | 2026-08-14 |