| NPI | 1235681602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60691734) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 75257) |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2020-01-31 |