| NPI | 1588091839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 14057) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA 60466765) |
| 183500000X Pharmacist (Licence: MT 17947) | |
| Enumeration Date | 2013-10-02 |
| Last Update Date | 2019-09-27 |