| NPI | 1790437010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0022700) |
| Additional Taxonomies | 1835P0200X Pharmacist, Pediatrics (Licence: CO PHA.0022700) |
| Enumeration Date | 2022-01-19 |
| Last Update Date | 2022-07-05 |