| NPI | 1013367952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH 60028117) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0014458) |
| 183500000X Pharmacist (Licence: AZ S11650) | |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2016-06-21 |