| NPI | 1831739432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 0023019) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA 61000583) |
| Enumeration Date | 2020-01-10 |
| Last Update Date | 2020-01-10 |