| NPI | 1841589108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00009480) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P5884) |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2011-04-06 |