| NPI | 1194891408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AK 1469) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00050998) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2013-01-11 |