| NPI | 1659777167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60418728) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 6999368-1701) |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2014-11-10 |