| NPI | 1235795964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WY 2954) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202206841) |
| 183500000X Pharmacist (Licence: CO PHA.0016439) | |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2019-10-03 |