| NPI | 1568600260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60179103) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 6153956-1701) |
| Enumeration Date | 2009-02-03 |
| Last Update Date | 2022-10-17 |