| NPI | 1841176682 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 90930) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03445375) |
| Enumeration Date | 2025-08-15 |
| Last Update Date | 2025-08-15 |