| NPI | 1215158274 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-08919) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 4997) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2012-02-22 |