| NPI | 1154697399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: KS 14359) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 14359) |
| 1835G0303X Pharmacist, Geriatric (Licence: KS 14359) | |
| Enumeration Date | 2012-03-30 |
| Last Update Date | 2018-07-30 |