| NPI | 1568854982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S023556) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60472209) |
| Enumeration Date | 2015-02-22 |
| Last Update Date | 2020-08-25 |