| NPI | 1205463601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 100048) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 15315) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2020-03-25 |