| NPI | 1568830891 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: MA PH238213) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: RI RPH05473) |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2020-12-17 |