| NPI | 1215223797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 6000384-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 6000384-8911) |
| 183500000X Pharmacist (Licence: OR RPH-0014245) | |
| 183500000X Pharmacist (Licence: WA PH60485475) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2015-08-23 |