| NPI | 1902320880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0023645) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP00008756) |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2021-09-20 |