| NPI | 1083014807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60406825) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S018196) |
| Enumeration Date | 2014-08-28 |
| Last Update Date | 2020-11-08 |