| NPI | 1407488802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0023721) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 82003) |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2022-01-24 |