| NPI | 1043646888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0020793) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP00008055) |
| Enumeration Date | 2013-09-25 |
| Last Update Date | 2018-04-20 |