| NPI | 1598133175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 0014922) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA 60582236) |
| Enumeration Date | 2015-09-12 |
| Last Update Date | 2015-09-12 |