| NPI | 1023543907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835C0207X Pharmacist, Compounded Sterile Preparations (Licence: KS 115525) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 115525) |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2026-07-06 |