| NPI | 1194102186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ps50966) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60560569) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2021-11-11 |