| NPI | 1649428590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0018539) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ s12200) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2025-03-18 |