| NPI | 1205191186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60993329) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 51523) |
| 183500000X Pharmacist (Licence: HI PH-4578) | |
| Enumeration Date | 2012-07-07 |
| Last Update Date | 2023-11-21 |