| NPI | 1629407515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-13816) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AK 1962) |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2013-11-01 |