| NPI | 1912300138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR PI-0010983) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA IR 60148871) |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2014-10-01 |