| NPI | 1649623802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-100064) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2016027170) |
| Enumeration Date | 2016-07-22 |
| Last Update Date | 2016-08-01 |