| NPI | 1558514851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 19516) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 14617) |
| Enumeration Date | 2008-10-30 |
| Last Update Date | 2008-10-30 |