| NPI | 1558423053 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 183500000X Pharmacist (Licence: OK 9005) | 
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 2431) | 
| Enumeration Date | 2006-12-14 | 
| Last Update Date | 2025-09-11 |