| NPI | 1386073955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-13763) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2004011455) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2013-11-05 |