| NPI | 1427319177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 0006575) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA 12165) |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2012-05-30 |