| NPI | 1780800557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2005036831) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202004177) |
| 183500000X Pharmacist (Licence: IL 051.027875) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2007-07-08 |