| NPI | 1639249428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA ph00051858) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P5745) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2022-06-09 |