| NPI | 1659900967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IL 051.302944) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03338067) |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2020-04-07 |