| NPI | 1700717329 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS68690) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-113268) |
| 183500000X Pharmacist (Licence: MO 2024033784) | |
| Enumeration Date | 2026-05-25 |
| Last Update Date | 2026-05-25 |