| NPI | 1689817702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IL 051.292388) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2007023994) |
| 183500000X Pharmacist (Licence: OH RPH.03234119-2) | |
| 183500000X Pharmacist (Licence: KY 017850) | |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2016-06-13 |