| NPI | 1053615484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60036741) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IL 051291756) |
| Enumeration Date | 2010-12-28 |
| Last Update Date | 2022-08-06 |