| NPI | 1235327123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00070885) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302034548) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2007-10-04 |