| NPI | 1043560634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 60221511) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 72130) |
| Enumeration Date | 2012-09-11 |
| Last Update Date | 2024-05-23 |