| NPI | 1942786579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2014023603) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IL 051.297675) |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2026-01-29 |