| NPI | 1558876755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 21450) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM 8825) |
| Enumeration Date | 2017-12-10 |
| Last Update Date | 2017-12-10 |