| NPI | 1093985053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS33297) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00009504) |
| Enumeration Date | 2008-03-06 |
| Last Update Date | 2008-03-06 |