| NPI | 1922601954 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA ph329420) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03136026) |
| 183500000X Pharmacist (Licence: PA RP450997) | |
| Enumeration Date | 2020-11-20 |
| Last Update Date | 2020-11-20 |