| NPI | 1730454380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: HI 3001) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00009182) |
| Enumeration Date | 2012-03-15 |
| Last Update Date | 2012-03-15 |