| NPI | 1912359423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-17124) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2016025451) |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2019-05-20 |