| NPI | 1215497425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 15812) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-105627) |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2022-04-05 |