| NPI | 1306070909 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PR 2114) |
| Additional Taxonomies | 332100000X Department of Veterans Affairs (VA) Pharmacy (Licence: IN 91225) |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2020-07-22 |