| NPI | 1255807772 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S023619) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO PHA.0022471) |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2018-10-23 |