| NPI | 1609475052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2017026909) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-104540) |
| Enumeration Date | 2020-10-17 |
| Last Update Date | 2020-10-17 |