| NPI | 1356401772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ 12833) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA 000048742) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2007-07-08 |