| NPI | 1972859155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-15170) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 0019445) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2014-02-20 |