| NPI | 1629144878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00016864) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IL 051030598) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2007-07-08 |