| NPI | 1710256730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-13614) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 9192) |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2011-12-20 |