| NPI | 1376944975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 64538) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IL 51294946) |
| 183500000X Pharmacist (Licence: TX 52637) | |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2014-09-15 |