| NPI | 1255952800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0022988) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA RPH79839) |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2020-05-05 |