| NPI | 1063769131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0021681) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS49048) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2023-04-25 |