| NPI | 1235142704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 41869) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IL 051-034401) |
| 183500000X Pharmacist (Licence: WI 10466-040) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2007-07-08 |