| NPI | 1508632431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-109505) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2023033920) |
| Enumeration Date | 2023-12-01 |
| Last Update Date | 2026-08-03 |