| NPI | 1104100379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-13300) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 19863) |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2011-10-05 |