| NPI | 1902308075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60409983) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 0013809) |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2018-03-05 |