| NPI | 1033365648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00056883) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0010449-P) |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2012-02-15 |