| NPI | 1598761199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 10180) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 40530) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2007-07-08 |