| NPI | 1609753532 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH035666) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VT 033.0135841) |
| Enumeration Date | 2025-08-20 |
| Last Update Date | 2025-10-16 |