| NPI | 1215228200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 9171) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 028619) |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2011-04-25 |