| NPI | 1730758186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2017026898) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-103121) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2021-09-28 |