| NPI | 1245906411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-103792) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2021032267) |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2021-08-18 |