| NPI | 1497380844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR RPH-0017352) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH61027735) |
| 183500000X Pharmacist (Licence: OH 03438887) | |
| Enumeration Date | 2020-03-05 |
| Last Update Date | 2020-03-05 |