| NPI | 1710317458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WY 3684) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO PHA.0020049) |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2022-06-09 |