| NPI | 1851784201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 57091) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DE A1-0004553) |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2017-03-30 |