| NPI | 1891248480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60668798) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP448646) |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2016-07-29 |