| NPI | 1306193974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA ph00017277) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P4975) |
| Enumeration Date | 2012-08-13 |
| Last Update Date | 2012-08-13 |