| NPI | 1154870905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0021517) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 3935) |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2016-09-21 |