| NPI | 1114543550 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302044686) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 76395) |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2020-06-22 |