| NPI | 1972051902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0022507) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 59076) |
| Enumeration Date | 2016-09-19 |
| Last Update Date | 2020-02-03 |