| NPI | 1740614924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-16800) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 19948) |
| Enumeration Date | 2013-08-24 |
| Last Update Date | 2022-10-19 |