| NPI | 1508149204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 11285) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 040404) |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2011-09-20 |