| NPI | 1316308695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302037396) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60301326) |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2016-03-14 |