| NPI | 1861752479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60266155) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 0013016) |
| 183500000X Pharmacist (Licence: AZ 12491) | |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2012-05-17 |