| NPI | 1508009093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00068682) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 3073ATI) |
| 152W00000X Optometrist (Licence: CA 7201) | |
| 152W00000X Optometrist (Licence: WA 00003295) | |
| 183500000X Pharmacist (Licence: OR 0008670) | |
| 183500000X Pharmacist (Licence: CA 31990) | |
| 183500000X Pharmacist (Licence: IL 051031416) | |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2009-04-13 |