| NPI | 1538512363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00008075) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO PHA0021706) |
| Enumeration Date | 2016-07-17 |
| Last Update Date | 2018-01-29 |