| NPI | 1083173355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 20146) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO PHA.22040) |
| Enumeration Date | 2019-03-17 |
| Last Update Date | 2026-06-09 |