| NPI | 1164972394 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 0015679) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MT 39813) |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2016-10-12 |