| NPI | 1902384050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 16120) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO PHA.0022232) |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2018-08-01 |