| NPI | 1255604799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 09600) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 29229) |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2012-02-14 |