| NPI | 1225446370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60577580) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S020653) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2016-03-02 |