| NPI | 1457785354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60391186) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 17368-40) |
| Enumeration Date | 2013-08-27 |
| Last Update Date | 2015-09-18 |