| NPI | 1235006933 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ND RPh6363) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 125620) |
| 183500000X Pharmacist (Licence: WI 21493-40) | |
| Enumeration Date | 2025-10-20 |
| Last Update Date | 2025-10-20 |