| NPI | 1558634766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DE A1-0002689) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 15773) |
| Enumeration Date | 2012-02-17 |
| Last Update Date | 2012-02-17 |