| NPI | 1912500919 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH233028) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: MA PH233028) |
| Enumeration Date | 2020-11-20 |
| Last Update Date | 2025-01-07 |