| NPI | 1710268461 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60221287) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0013452) |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2013-01-25 |