| NPI | 1174891097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 11848) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2011006694) |
| 183500000X Pharmacist (Licence: IA 21398) | |
| Enumeration Date | 2011-12-06 |
| Last Update Date | 2011-12-06 |