| NPI | 1194246249 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH237115) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 68248) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2017-06-29 |