| NPI | 1063936664 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OK 16299) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-17080) |
| 183500000X Pharmacist (Licence: MO 2015026125) | |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2017-07-26 |