| NPI | 1487926051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 6124567-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0015237) |
| 183500000X Pharmacist (Licence: WA PH60600455) | |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2017-04-03 |