| NPI | 1912256926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00018685) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AK 1593) |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2012-12-14 |