| NPI | 1356628788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S013818) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00051309) |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2011-11-14 |