| NPI | 1992195648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 029525) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-09756) |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2015-02-03 |