| NPI | 1083060693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 60560940) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P5965) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2016-05-12 |