| NPI | 1881291797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00010502) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: HI PH2832) |
| Enumeration Date | 2020-10-04 |
| Last Update Date | 2020-10-15 |