| NPI | 1023534120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0023147) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0010262) |
| 183500000X Pharmacist (Licence: KY 019490) | |
| Enumeration Date | 2017-08-21 |
| Last Update Date | 2020-09-29 |