| NPI | 1346508462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA Ph00016873) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA RPH 32034) |
| 183500000X Pharmacist (Licence: NV 07283) | |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2012-04-26 |