| NPI | 1164094884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0023691) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO PHA.0023961) |
| Enumeration Date | 2021-07-13 |
| Last Update Date | 2022-06-01 |