| 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 | 2025-01-24 |