| NPI | 1861634891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60169096) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 60224) |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2012-07-02 |