| NPI | 1912296575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DE A1-0002005) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP028459L) |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2011-04-05 |