| NPI | 1225477532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0022570) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 55772) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2022-07-28 |