| NPI | 1003102765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH 00061759) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0010531) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2011-06-21 |