| NPI | 1003281478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0021109) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 3859) |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2015-12-09 |