| NPI | 1679825913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2010014031) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IL 051.292028) |
| Enumeration Date | 2012-10-10 |
| Last Update Date | 2015-03-27 |