| NPI | 1659800670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 0021953) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: CO 0002005950) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2017-09-08 |