| NPI | 1760815351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 53724) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO PHA.0023079) |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2021-08-13 |