| NPI | 1598210072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60681503) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 19347) |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2019-10-23 |