| NPI | 1164054052 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR RPH0017215) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 22223) |
| Enumeration Date | 2020-02-07 |
| Last Update Date | 2020-09-06 |