| NPI | 1609104686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR RPH-0011901) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH 00009611) |
| 183500000X Pharmacist (Licence: ID P4932) | |
| Enumeration Date | 2009-12-02 |
| Last Update Date | 2009-12-02 |