| NPI | 1013563253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 66083) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS59281) |
| 183500000X Pharmacist (Licence: IL 051.302187) | |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2025-12-11 |