| NPI | 1124475850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA IR60376907) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR PI0011668) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2016-05-23 |