| NPI | 1639422967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AK 1901) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA rp035890L) |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2012-10-24 |