| NPI | 1265982490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0021538) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 18500-40) |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2017-06-13 |