| NPI | 1841544079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60291255) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH0013198) |
| Enumeration Date | 2012-11-09 |
| Last Update Date | 2012-11-09 |