| NPI | 1164159554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0024840) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS64536) |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2025-10-13 |