| NPI | 1366840316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 22987) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DE A10004686) |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2014-12-08 |