| NPI | 1225430945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 20408) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DE A1-0004214) |
| Enumeration Date | 2014-09-25 |
| Last Update Date | 2017-02-15 |