| NPI | 1003189762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 13413-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IL 051.028504) |
| Enumeration Date | 2012-02-10 |
| Last Update Date | 2012-02-10 |