| NPI | 1629379623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID p5208) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA ph00019086) |
| Enumeration Date | 2010-11-06 |
| Last Update Date | 2010-11-06 |