| NPI | 1063608172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P4976) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00018504) |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2009-02-24 |