| NPI | 1447341938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00042598) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ 14683) |
| 183500000X Pharmacist (Licence: NV 16686) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2007-07-08 |