| NPI | 1588183750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WY 3983) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO PHA.0021975) |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2017-09-19 |