| NPI | 1326546540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-16659) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 68126) |
| Enumeration Date | 2018-01-23 |
| Last Update Date | 2022-04-21 |