| NPI | 1386911964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IL 051.286571) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302031746) |
| 183500000X Pharmacist (Licence: KY 013103) | |
| 183500000X Pharmacist (Licence: OR RPH-0011863) | |
| Enumeration Date | 2011-11-25 |
| Last Update Date | 2011-11-25 |