| NPI | 1699051201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 5412596-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60247604) |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2011-10-26 |