| NPI | 1497489421 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-110623) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: NE 16226) |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2022-07-25 |