| NPI | 1710604194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0023452) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH233953) |
| Enumeration Date | 2022-10-26 |
| Last Update Date | 2022-10-26 |