| NPI | 1659583508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00039768) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ 11281) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2010-12-03 |