| NPI | 1447622253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA0020861) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP036672L) |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2015-10-20 |