| NPI | 1164799300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-14958) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 43356) |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2011-11-16 |