| NPI | 1770860256 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 18204) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: CO 18204) |
| Enumeration Date | 2011-11-10 |
| Last Update Date | 2020-12-29 |