| NPI | 1659396869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-14437) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 16750) |
| 183500000X Pharmacist (Licence: UT 6348369-1701) | |
| 183500000X Pharmacist (Licence: MO 2008016516) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2012-05-22 |