| NPI | 1700176724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P3399) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 5245) |
| 183500000X Pharmacist (Licence: WA PH7901) | |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2011-04-11 |