| NPI | 1922656719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: WA IR60690612) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: FL PSI40233) |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2019-08-27 |