| NPI | 1174894117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00056975) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 0010968) |
| Enumeration Date | 2012-01-23 |
| Last Update Date | 2012-01-23 |