| NPI | 1336599919 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NH 3889) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH235812) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2016-06-15 |