| NPI | 1679192413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 125399) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO PHA.0022764) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO PHA.0022764) | |
| Enumeration Date | 2020-04-12 |
| Last Update Date | 2021-09-21 |