| NPI | 1619673936 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH241341) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: RI Rph00508-T) |
| Enumeration Date | 2023-02-07 |
| Last Update Date | 2023-02-07 |