| NPI | 1952877318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-103179) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2017030951) |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2018-10-23 |