| NPI | 1790051696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 12550) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 041604) |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2012-03-26 |