| NPI | 1689145765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 41000) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MT 3811) |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2018-12-16 |