| NPI | 1609138064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60224879) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0012709) |
| 183500000X Pharmacist (Licence: KS 1-15064) | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2019-11-04 |