| NPI | 1780074690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA ph60458899) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 62056) |
| Enumeration Date | 2015-01-29 |
| Last Update Date | 2015-08-05 |