| NPI | 1093000440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60170167) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK R-14853) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2011-06-14 |