| NPI | 1831453844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60645271) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA IR60233273) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2016-08-31 |