| NPI | 1205164779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0021939) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202207917) |
| 1835P2201X Pharmacist, Ambulatory Care (Licence: CO 21939) | |
| Enumeration Date | 2009-11-22 |
| Last Update Date | 2022-05-27 |