| NPI | 1174869598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA ph60292403) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL ps45616) |
| Enumeration Date | 2012-12-13 |
| Last Update Date | 2014-11-22 |