| NPI | 1215538400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-100802) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: MO 2020025333) |
| Enumeration Date | 2020-11-04 |
| Last Update Date | 2020-11-04 |