| NPI | 1891041604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH70715) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 62095) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2012-07-30 |