| NPI | 1538410352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 68765) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60280213) |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2014-10-07 |