| NPI | 1114354214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MT PHA-PHA-LIC-15025) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IL 051.036002) |
| 183500000X Pharmacist (Licence: CO PHA.0019838) | |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2014-07-30 |