| NPI | 1255771663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0024226) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 53041) |
| Enumeration Date | 2013-06-29 |
| Last Update Date | 2023-12-11 |