| NPI | 1649384207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ 7193) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-09983) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2014-11-11 |