| NPI | 1003162967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA Ph60256880) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL Ps40945) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2012-07-30 |