| NPI | 1336336742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00039038) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 36379) |
| Enumeration Date | 2007-09-29 |
| Last Update Date | 2007-09-29 |