| NPI | 1578995361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IL 051.295808) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202212180) |
| 183500000X Pharmacist (Licence: NC 31580) | |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2026-06-16 |