| NPI | 1467129775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0013204) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-103645) |
| 333600000X Pharmacy (Licence: KS 1-103645) | |
| 3336I0012X Pharmacy, Institutional Pharmacy (Licence: KS 1-103645) | |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2022-07-10 |