| NPI | 1528463668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID p3991) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: WA ph00009889) |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2014-10-31 |