| NPI | 1548540172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 16603) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS KS1-13891) |
| Enumeration Date | 2011-08-26 |
| Last Update Date | 2016-01-30 |