| NPI | 1972107092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-16005) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2013024740) |
| Enumeration Date | 2020-11-30 |
| Last Update Date | 2020-11-30 |