| NPI | 1609153667 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-15001) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 50761) |
| Enumeration Date | 2011-11-04 |
| Last Update Date | 2011-11-04 |