| NPI | 1659427524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: HI PH 1435) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PL 11243) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2007-07-08 |