| NPI | 1770952749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 36051) |
| Additional Taxonomies | 1835P2201X Pharmacist Ambulatory Care (Licence: CO PHA.0021571) |
| Enumeration Date | 2015-09-21 |
| Last Update Date | 2025-07-01 |