| NPI | 1811472780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60876995) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0016880) |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2018-09-26 |