| NPI | 1225319395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-11866) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 43283) |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2011-09-02 |