| NPI | 1558772434 |
|---|---|
| Former Name | OLIVIA REGINA SANTOSO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 22881) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA 026916) |
| 225000000X Orthotic Fitter (Licence: 1722) | |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2015-12-24 |