| NPI | 1144816273 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 061664-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA 448900) |
| Enumeration Date | 2020-12-13 |
| Last Update Date | 2020-12-13 |