| NPI | 1851649545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-14788) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 015561) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2012-08-28 |