| NPI | 1487103008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00019381) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH0008901) |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2019-06-07 |