| NPI | 1104540277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 56465) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 12890-40) |
| 183500000X Pharmacist (Licence: IL 051.039862) | |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2022-10-03 |