| NPI | 1114138690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 61094) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 10670) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2009-04-20 |