| NPI | 1164831202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00008104) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO PHA.0020789) |
| Enumeration Date | 2014-08-02 |
| Last Update Date | 2024-08-30 |