| NPI | 1225421746 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2014033325) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-16936) |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2015-03-09 |