| NPI | 1609061662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00006000) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60188349) |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2015-05-19 |