| NPI | 1467865576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 00009878) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0012263) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2014-06-05 |