| NPI | 1245515311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH 00010227) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA RPH 31690) |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2011-10-20 |