| NPI | 1730445537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR rph-001475) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA ph 000136) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2012-04-05 |