| NPI | 1316047863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DE A1-0002616) |
| Additional Taxonomies | 1835P1300X Pharmacist Psychiatric (Licence: DE A1-0002616) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-07-08 |