| NPI | 1497097885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WY 2589) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IL 051303891) |
| 183500000X Pharmacist (Licence: CO 10452) | |
| Enumeration Date | 2013-03-23 |
| Last Update Date | 2026-05-01 |