| NPI | 1407897911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00010112) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AK 560) |
| 183500000X Pharmacist (Licence: HI 602) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2007-07-08 |