| NPI | 1326480195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID p6827) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA ph60344776) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2013-07-22 |