| NPI | 1912507252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IL 051.294666) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 11689-40) |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2021-09-08 |