| NPI | 1942567425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA IR 60151855) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID E14889) |
| 183500000X Pharmacist (Licence: CA INT 27392) | |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2012-04-20 |