| NPI | 1326263013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IL 051-290900) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03-3-26716) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2007-07-08 |