| NPI | 1174117758 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 020398) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IN 26026341A) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 26026341A) | |
| Enumeration Date | 2021-02-24 |
| Last Update Date | 2024-10-09 |