| NPI | 1457900466 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH239765) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA rp453919) |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2021-06-16 |