| NPI | 1881936813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 16626-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IL 051.295678) |
| 183500000X Pharmacist (Licence: MO 2008018173) | |
| Enumeration Date | 2013-03-16 |
| Last Update Date | 2013-03-16 |