| NPI | 1205378635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 66003) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO PHA.0022626) |
| 183500000X Pharmacist (Licence: WY 4098) | |
| 183500000X Pharmacist (Licence: ID P8197) | |
| Enumeration Date | 2016-11-16 |
| Last Update Date | 2022-03-02 |