| NPI | 1891790549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR RPH-0010070) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MT 3984) |
| 183500000X Pharmacist (Licence: WA PH00052231) | |
| Enumeration Date | 2005-06-18 |
| Last Update Date | 2014-10-17 |