| NPI | 1982321816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1106931) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2024050365) |
| Enumeration Date | 2022-10-21 |
| Last Update Date | 2025-09-08 |