| NPI | 1811508104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0025408) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 4250) |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2025-11-04 |