| NPI | 1043563521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 16120) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP00007812) |
| 183500000X Pharmacist (Licence: NE 11632) | |
| Enumeration Date | 2012-10-20 |
| Last Update Date | 2020-04-02 |